| Objective:327 patients with hydatidiform mole were retrospectively analyzed to summarize and analyze the clinicopathological characteristics,treatment plan,clinical outcome and related factors of malformation of hydatidiform mole,and to explore the changes of clinical characteristics and related factors of malformation of hydatidiform mole.Materials and Methods:The clinical medical records of 327 patients with hydatidiform mole who were treated in the Affiliated Hospital of Qingdao University from May 2000 to December2019 were collected,and they were clearly diagnosed by pathology examination after the first clearance of the uterus in our hospital.Including age,menopause time,pregnancy and delivery,history of hydatidiform mole,clinical manifestations,times of clearing of uterus,prophylactic chemotherapy,pathology result and other related factors.Database was established.The general information,clinical manifestations,auxiliary examinations,treatment and malignant changes of 327 patients were summarized.The patients were divided into two groups according to the time of admission and diagnosis for the first time.SPSS23.0 statistica l software was used,and the rank sum test and chi-square test were used for analysis according to different counting and measurement data.The changes in clinical characteristics of patients with hydatidiform mole in recent 20 years were compared.The patients were divided into two groups according to the different times of clearance,and the differences of clinical data among patients with different times of clearance were compared.The related medical records of malformation cases were also analyzed by rank sum test or chi-square test or Logistic or ROC to study the changes in the risk factors of malformation of hydatidiform mole.Results:1.From May 2000 to December 2019,327 cases of hydatidiform mole were admitted,including 179 cases of complete hydatidiform mole(54.7%)and 148 cases of partial hydatidiform mole(45.3%).The median age of onset was 31 years old,including 158 patients(48.3%)?30 years old,94 patients(28.7%)31-40 years old,and 75 patients(23.0%)?41 years old with.The median duration of menopause was66 days.Among them,245 patients(74.9%)had vaginal bleeding,104 patients(31.8%)had abdominal pain,84 patients(25.7%)had abnormal uterine enlargement(?2 weeks of gestational age),11 patients(3.4%)had luteinized cyst of ovary(?6cm),10 patients(3.1%)had hyperemesis gravidarum.Pregnancy hypertension was found in 7 patients(2.1%).The median value of serum ?-h CG was 193506.0m IU/ml before hysteresis,and the median size of lesion on ultrasound ex amination was5.9cm.Among them,the ultrasound examination of complete hydatidiform mole was consistent with the pathology after hysteresis in 130 cases(72.6%),and that of partial hydatidiform mole in 42 cases(28.4%),the ultrasonic detection rate of partial hydatidiform mole was significantly lower than complete hydatidiform mole(P <0.05).29 patients(8.9%)received prophylactic chemotherapy and 18 patients(5.5%)received prophylactic hysterectomy.A total of 56 patients(17.1%)developed malignant transformation,including 22 patients(13.9%)?30 years old,12 patients(12.8%)31-40 years old,and 22 patients(29.3%)with?41 years old.All patients with malignant transformation were cured after treatment and no patients died ?2.Divided into two groups according to admission diagnosis time.From May2000 to December 2009,83 cases were classified as group I.From January 2010 to December 2019,244 patients were assigned to group II.In group I,there were 54 cases of complete mole(65.1%)and 29 cases of partial mole(34.9%).The median duration of menopause was 73 days.71 cases(85.5%)had vaginal bleeding.Abnormal uterine enlargement in 39 cases(47.0%);luteinized cyst of ovary7 cases(8.4%);6 cases of hyperemesis gravidarum(7.2%);5 cases of hypert ension during pregnancy(6.0%);The median diameter of ultrasonic lesions was 6.7cm,among which,the ultrasonic examination of complete hydatidiform mole was consistent with the pathological diagnosis after hysterectomy in 26 cases(66.7%),and that of partial hydatidiform mole was consistent with the pathological diagnosis after hysterectomy in 7 cases(24.1%).The median of serum ?-h CG before cleavage was 293705.0 m IU/ml.23 cases(27.7%)received prophylactic chemotherapy;8 cases(9.6%)were given prophylactic hysterectomy.There were 9 cases(10.8%)of malignant transformation.In group II,125 cases(51.2%)were complete mole and119 cases(48.8%)were partial mole.The median duration of menopause was 65days;174 cases of vaginal bleeding(71.3%);45 cases o f abnormal uterine enlargement(18.4%);4 cases of luteinized cyst of ovary(1.6%);4 cases of hyperemesis gravidarum(1.6%);2 cases of hypertension during pregnancy(0.8%);the median diameter of ultrasonic lesions was 5.7cm,in which 94 cases(75.2%)of complete hydatidiform mole and 35 cases(29.4%)of partial hydatidiform mole were consistent with the pathological diagnosis after hysterectomy.The median of serum ?-h CG was 162582.0 m IU/ml,and 6 patients(2.5%)received prophylactic chemotherapy.Preventive hysterectomy was performed in 10 cases(4.1%),and malignant transformation occurred in 47 cases(19.3%).Comparison between the two groups for the above study factors,completeness hydatidiform mole and part of the sex hydatidiform mole ratio is closer to,as time goes on,the patient at the time of the menopause time shortened,the patients of vaginal bleeding reduced,the patients ofuterine abnormal enlargement reduced,lufovariancyst reduced,hyperemesis gravidarum reduced,gestational hypertension reduced,serum?-h CG value before uterine curettagewas more and more lower,The differences were statistically significant(P < 0.05).The diagnostic accuracy of complete hydatidiform mole and partial hydatidiform mole showed an increasing trend,but there was no statistical difference between the two groups(P >0.05).3.The patients were divided into two groups according to the times of clearing.Group A was cleared once,with A total of 253 cases(77.4%).In group B,74 cases(22.6%)were cleared twice.No three times and more than three times.The median age of group A was 30 years old,57 cases of abnormal uterine enlargement(22.7%),5 cases of luteinated cyst of ovary(2.0%),14 cases of prophylactic chemotherapy(5.6%),10 cases of prophylactic hysterectomy(4.0%),and the median diameter of ultrasonic lesion was 5.7cm.The median of serum ?-h CG was 166724.5 m IU/ml,and33 patients(13.0%)had malignant transformation.The median age of group B was35 years old,27 cases of abnormal uterine enlargement(36.5%),6 cases of luteinated cyst of ovary(8.1%),15 cases of prophylactic chemotherapy(20.3%),8cases of prophylactic hysterectomy(10.8%),and the median diameter of ultrasonic lesion was 7.0cm.The serum ?-h CG was 343600.0 m IU/ml.23 patients hadmalignant transformation(31.1%).The differences of the above factors between the two groups were statistically significant(P < 0.05).4.The patients were divided into malignant transformation group and non-malignant transformation group.56 patients(17.1%)were malignant transformation group,the median age was 35 years,21 patients(37.5%)had abnormal uterine enlargement,8 patients(14.3%)had luteinized cyst of ovary,and the median size of ultrasonic lesion was 6.4cm.The median serum ?-h CG value before curettage was 252326.0 m IU/ml,and 23 patients(41.1%)received second curettage.In the non-malignant group,there were 271 patients(82.9%),the median age was 30 years old,63 patients(23.4%)had abnormal uterine enlargement,3patients(1.1%)had luteinized cyst of ovary,the median diameter of ultrasound lesion was 5.8cm,the median of serum ?-h CG value was 179,017 m IU/ml before clearance,and 51 patients(18.8%)received secondary clearance.There were 179 cases of complete mole,39 cases of malignant transformation(21.8%),148 cases of partial mole,17 cases of malignant transformation(11.5%).The differences between the two groups were statistically significant when comparing the above factors(P <0.05).Logistic univariate and multivariate regression analysis was performed for all related factors,in which age,luteinized cyst of ovary,size of ultrasonic lesion and serum ?-h CG value before uterine clearance were independent influencing factors for malignancy of hydatidiform mole(P < 0.05).The ROC curve analysis of age,size of ultrasonic lesion and serum ?-HCG value before cleavage showed that the optimal cut-off value for predicting malformation of hydatidiform mole was 42 years old,7.65 cm,and 132823.5 m IU/m L.Conclusion:1.In recent years,the visiting time of hydatidiform mole patients moved forward,the incidence of vaginal bleeding,abnormal uterine enlargement and ovarian luteinized cyst decreased,and the serum ?-HCG value before cleavage also showed a decreasing trend.2.The patient's age,combined with lentiinized cyst of ovary,size of ultrasonic lesion and serum ?-HCG value of preteravoratory were independent influencing factors for malignant degeneration of hydatidiform mole,and also high risk factors for patients with secondary hysteravoratory.Among them,the age of > 42 years old,the ultrasound lesion > 7.65 cm,and the serum ?-HCG value of preteravoratory >132823.5 m IU/m L were the highest.Predicts increased risk of malignancy in hydatidiform mole. |
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